RA Messages for May 1, 2007
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT
THE PBM HELP DESK AT 1-800-648-0790.
PLEASE FILE ADJUSTMENTS FOR CLAIMS THAT MAY HAVE BEEN INCORRECTLY
PAID. ONLY THOSE PRODUCTS OF THE MANUFACTURERS WHICH PARTICIPATE IN THE FEDERAL
REBATE PROGRAM WILL BE COVERED BY THE MEDICAID PROGRAM. PARTICIPATION MAY BE
VERIFIED IN APPENDIX C, AVAILABLE AT
WWW.LAMEDICAID.COM
ATTENTION PROVIDERS
EFFECTIVE 7-2-2007, IN ACCORDANCE WITH
A RECENT DHH DIRECTIVE, UNISYS WILL NO LONGER ACCEPT COPIES OF STANDARD
CLAIM FORMS, THE REGULATIONS DO NOT ALLOW THE COPYING OF HARDCOPY CLAIM
FORMS. THESE INCLUDE THE UB-92, UB-04, CMS 1500 (12-90), CMS 1500
(08-05), ADA, AND THE NCPDP UNIVERSAL CLAIM FORM. ANY HARD COPY CLAIMS
SUBMITTED TO UNISYS FOR PROCESSING MUST BE AN ORIGINAL, STANDARD CLAIM
FORM AND MUST MEET THE LICENSURE/ COPYRIGHT REQUIREMENTS OF THE
PARTICULAR ORGANIZATION THAT REGULATES THAT CLAIM FORM. THIS INCLUDES
ORIGINAL SUBMISSIONS, RE-SUBMISSIONS OF PREVIOUS CLAIMS, AND CLAIM
ADJUSTMENTS/VOIDS.
WITH THE IMPLEMENTATION OF THIS
REQUIREMENT, PROVIDERS THAT ARE ROUTINELY BILLING ALL CLAIMS HARD COPY
MAY WANT TO CONSIDER TRANSITIONING TO ELECTRONIC CLAIMS SUBMISSION.
QUESTIONS CONCERNING EDI BILLING MAY BE DIRECTED TO THE UNISYS EDI
DEPARTMENT AT 225/216-6000, OPTION 2. A COMPLETE LISTING OF APPROVED EDI
VENDORS IS AVAILABLE ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM,
LINK HIPAA INFORMATION CENTER/LINK VBC LIST. PLEASE CONTACT THE VENDORS
FOR SPECIFIC INFORMATION ON THEIR SERVICES AS A WIDE RANGE OF
PACKAGES/FEES ARE AVAILABLE.
ATTENTION PROVIDERS - PROPOSED CLASS
ACTION SETTLEMENT
A PARTIAL SETTLEMENT HAS BEEN REACHED
IN A LAWSUIT INVOLVING FOCUS HEALTHCARE MANAGEMENT AND OTHER
NON-SETTLING DEFENDANTS FOR POSSIBLE FAILURE TO PROVIDE APPROPRIATE
NOTICE BEFORE PPO DISCOUNTS WERE APPLIED TO PROVIDERS' BILLS SUBMITTED
UNDER THE LOUISIANA WORKERS' COMPENSATION LAW. INFORMATION IS AVAILABLE
BY CALLING 1-800-469-0247 OR GOING TO THE WEBSITE,
WWW.FOCUSSETTLEMENT.COM.
ATTENTION PROVIDERS
THE 2007 HCPCS CODES HAVE BEEN LOADED
TO OUR FILES AND MAY BE SUBMITTED FOR DATES OF SERVICE JANUARY 1, 2007
FORWARD. LOOK FOR THE UPDATED 2007 FEE SCHEDULE ON THE LOUISIANA
MEDICAID WEBSITE, WWW.LAMEDICAID.COM, IN
ATTENTION REHABILITATION
PROVIDERS
WE EXPERIENCED INTERNAL CODING ERRORS
WITH REGARDS TO SOME REHABILITATION HCPCS BACK IN 2005. ALTHOUGH THE
PROGRAMMING WAS CORRECTED, BOTH DENIED AND OVERPAID CLAIMS WERE NOT
RECYCLED. CLAIMS WHICH WERE INADVERTENTLY OVERPAID HAVE BEEN ADJUSTED ON
THE REMITTANCE ADVICE DATED APRIL 10, 2007. CLAIMS WHICH WERE
INAPPROPRIATELY DENIED HAVE BEEN RECYCLED ON REMITTANCE ADVICES DATED
APRIL 10 AND 17, 2007.
ATTENTION PROVIDERS - NATIONAL
PROVIDER IDENTIFIER
DHH HAS LAUNCHED A NEW NPI WEB
REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA
MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING
MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING
THE NPI NUMBER BEGINNING 23-MAY-07. THE NEW NPI APPLICATION IS
ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF
THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI
INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM>
HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).